Chest presses, not breaths, help CPR

A recent study in Japan showed that people were more likely
to recover without brain damage if rescuers focused on chest compressions
rather than rescue breaths, and some experts advised dropping the
mouth-to-mouth part of CPR altogether. The study was published in a recent
issue of the medical journal The Lancet.

More than a year ago, the American Heart Association revised
its longstanding CPR guidelines to put more emphasis on chest presses, urging
30 instead of 15 for every two breaths given. Stopping chest compressions to
blow air into the lungs of someone who is unresponsive detracts from the more
important task of keeping blood moving to provide oxygen and nourishment to the
brain and heart.

Another big advantage to dropping or at least diminishing
the rescue breaths: It could make bystanders more willing to provide CPR in the
first place. Many are unwilling to do the mouth-to-mouth part and become
flummoxed and fearful of getting the ratio right in an emergency.

Sudden cardiac arrest — when the heart suddenly stops
beating — can occur after a heart attack or as a result of electrocution or
near-drowning. It’s most often caused by an abnormal heart rhythm. The person
experiencing it collapses, is unresponsive to gentle shaking and stops normal
breathing.

In the new study, researchers led by Dr Ken Nagao of
Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who
had cardiac arrest witnessed by bystanders. Of those, 439 received chest
compressions only from bystanders, and 712 received conventional CPR —
compressions and breaths.

Any CPR attempt improved survival odds. However, 22 percent
of those who received just chest compressions survived with good neurological
function compared with only 10 percent of those who received combination CPR.

“Eliminating the need for mouth-to-mouth ventilation
will dramatically increase the occurrence of bystander-initiated resuscitation
efforts and will increase survival,” Dr. Gordon Ewy, a cardiologist at the
University of Arizona College of Medicine in Tucson, wrote in an accompanying
editorial.

A big caveat: The combination CPR in the Japanese study was
given according to the old guidelines of 15 presses for every two breaths, not
the 30 presses recommended now.

The American Heart Association said the study supports a
focus on chest presses, but the association does not expect its advice to
change. It recommends that bystanders provide compression-only CPR if they are
“unwilling or unable” to do mouth-to-mouth breathing at the same time
and for emergency dispatchers to give instructions on that.

The association wants to see survival results from programs
that use compression-only CPR for cardiac arrest.

“It is important to note that victims of cardiac arrest
from non-cardiac causes, like near-drowning or electrocution, and almost all
victims of pediatric cardiac arrest benefit from a combination of rescue
breathing and chest compressions,” a heart association statement says.

More than 300,000 Americans die from cardiac arrest each
year. About 75 percent to 80 percent of all cardiac arrests outside a hospital
happen at home, and effective CPR can double a victim’s chance of survival.

Roughly 9 out of 10 cardiac arrest victims die before they
get to the hospital — partly because they don’t get CPR.